A femoral neck fracture often occurs at an advanced age when the patient falls to the side or onto the knee. The age-related change in the bone as well as an increased risk of falling make the femoral neck fracture one of the most common fractures in older people. Women are more likely to be affected by an increased risk of osteoporosis.
The neck of the femur can also fracture in accidents involving the application of enormous force. The fracture can affect different areas of the femoral neck and is therefore divided into different classes. A distinction is made between medial, intermediate and lateral fractures of the femoral neck (SHF). A further classification is based on Pauwels and describes the fracture angle and thus the degree of stability of the fracture. The therapy can be performed surgically or conservatively.
Symptoms
The main symptoms of a femoral neck fracture (SHF) are initially the classic fracture signs: pain, swelling, functional impairment, possible crepitations (noise during movement). The patient is unable to put any weight on the affected leg. Depending on the course of the fracture, a malposition of the leg in external rotation can be accompanied by a shortening of the leg.
The leg can also deviate inwards or outwards from the midline (valgus/varus position). In the first days after the fracture, there is usually a severe swelling with hematoma formation, which can be painful for the patient. In the days that follow, the patient’s ability to work under stress and mobility strongly depends on the chosen treatment method and can vary from patient to patient.
What is the treatment after the surgery?
Especially after a surgical procedure for SHF, the patient is usually able to resume his or her physical activity a few days after surgery and rehabilitative therapy can be started. How intensively the leg can be loaded again after the treatment depends on the individual doctor’s instructions. In the early phase, gentle treatment techniques are used to promote regeneration and healing of the tissue.
Early mobilization is especially important for older patients to counteract immobility. If the patient is allowed and able, as much as possible is carried out independently. In any case, the pain limits must be observed.
If the fracture is resilient, getting up and walking is practiced in the first few days to counteract circulatory problems. Especially in the early stages, the use of manual lymphatic drainage can also be helpful to relieve tension and pain and promote healing. Movements that should be avoided at all costs are crossing over the legs, turning in the hips (rotational movements) and lying on one’s side.
Transfers should be practiced during therapy to avoid unintentional incorrect loading of the fracture when changing position. The mobility of the surrounding joints (e.g. ankle and knee joint) can also be affected by the lack of freedom of movement of the leg and should be taken into account by targeted mobilization during therapy. With increasing time, the fracture’s resilience increases and the intensity of strengthening and mobilization exercises can be increased. Gait training is becoming more and more important, and physiological movements such as squats (standing/sitting down) or climbing stairs should be practiced so that the patient can safely master everyday life. In a follow-up healing treatment, the intensity of the therapy is increased once again and remaining problems can be addressed individually.
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